AMENDED BOOKLET-INFUENCING CHANGE

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This booklet aims to educate and inform nearly qualifying nurses the
necessary steps to influencing change within the work place.
Contents

 Definition of change.
 Change management theory.
 A framework called the PARiHS (Promoting Action on Research

Implementation in Health Services) framework and it can be
used to evaluate the readiness for change in a specific clinical
area.
 Understanding barriers to change.
 Suggested change in mental health nursing.
 How influencing change relate to your role as a newly qualified
nurse.
 How influencing change relate to the organisation and
management of patient care.
 Tips for peers in preparation for their new role and the ability
to influence change.

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Definition of Change

Change is defined as “an
attempt to alter or replace
existing skills, attitude,
norms and styles of
individuals and groups”
(Wright 2003).

Why might we suggest change?

• changes in knowledge and care delivery
• nursing role development
• alterations in regulatory bodies' professional standards
• the shifting health needs in the population the nursing

profession serves
• Improve services
(Iwasiw et al., 2009; Keating, 2011).

Change management theory

Lewin’s Change of theory

The change theory of nursing was developed by Lewin in
1951. Lewin’s model was based on behaviour which he defined it as
a dynamic balance of forces working in opposite directions. The
concept of the theory was based on 3 major concepts.

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 Driving force – push in a direction that causes change to occur
 Restraining force – force which counters the driving force
 Equilibrium – driving force equals restraining forces and no

change occurs.
In terms of nursing there are three major stages to this theory which
focuses on prior learning to be replaced and rejected. And it is as
follows:

 Unfreezing – involves finding a method of making it possible for
people to let go of an old pattern that was counter productive

 Change – involves a process of change of thoughts, feeling or
behaviour

 Refreezing – establishes the change as the new habit so it
becomes the standard operating procedure.

LEWIN’S THREE STAGE PROCESS OF CHANGE

Planning change in nursing is required but to implement it can be
difficult. If managers and other professionals can understand the
theory framework for change then the possibility for success is
heightened. (Mitchelle, 2013).

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Evaluating the readiness for change in a
specific clinical area.

A framework called the PARiHS (Promoting Action on Research
Implementation in Health Services) can be used to evaluate the
readiness for change in a specific clinical area (Kitson et al., 1998;
Rycroft Malone et al., 2002; 2004).

The diagram above portrays the increased likelihood that a proposed
change can be successfully integrated in to a clinical practice when all
the three elements of the PARiHS framework has been considered
and all members of the team buy in to the proposed change (Kitson
et al.,1998 ; Raycroft Malone et al.,2004).

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Kitson et al. (1998) and Rycroft Malone et al.( 2004) also believes
that successful implementation is most likely to occur when;

 Scientific evidence is viewed as sound and fitting with
professional and patient beliefs.

 The healthcare context is receptive to implementation in
terms of supportive leadership, culture, and evaluative
systems.

 There are appropriate mechanisms in place to facilitate
implementation

Understanding barriers to change

According to NICE (2007), there are certain barriers that can hinder
nurses desire to make changes to their work environment.

These barriers are as follows:
• Awareness and knowledge- knowledge of what needs to
change and why, are vital first steps in enabling change to
occur.
• Motivation - Drive and desire to improve are very
important. Intentions and goals can impact on how much
people want to change. Their priorities and commitments
may also interfere with their ability to change.

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• Acceptance and beliefs- A person’s belief in their own
ability to adopt a new behaviour also has an impact on
whether a change is implemented.

• Skills -to make change happen, individuals need to know
not only about what needs to change, but also how best to
competently carry out the change (Bayliss- Platt 2016).

• Practicalities -practical barriers can involve a lack of
resources or personnel, or difficulties in establishing service
delivery.

• External environment- the financial and political
environment can impact on healthcare professionals’
desire, motivation and ability to make changes (Cuts in
mental health).

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How influencing change relate to the
organisation and management of patient
care.

Qualified nurses are expected to maintain or improve quality of
service according to the NMC Code (NMC, 2015).
The area of the code that deals with this topic is section 25  
“Identify priorities, manage time, staff and resources effectively and
deal with risk to make sure that the quality of care or service you
deliver is maintained and improved, putting the needs of those
receiving care or services first.”  
 

Change is facilitated through clinical audits

Design is all important, University Hospitals Bristol (2009).
• Ensure staff are motivated to change
 Involve everyone who will have a final say
 Get management to support any costs.
 Ensure your methodology is robust.

 

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Recommendations on change:

The Francis report recommended that team leaders were vital for
the delivery of safe care (2013).
 
NHS England (2016) nursing framework advices that reflective
practice is required in order to improve patient outcomes –
but people may need support to make changes. 
 
Article that demonstrates how a team were empowered to embrace
change – looking at reasons why people were resistant to change
and the steps taken to ensure that everyone in the team was
proficient in the new system.  This was successful in reducing time
spent on administration when allocating patient visits (Bowers 2011).

The Art of Storytelling in Influencing Change

Through stories we as nursing practitioners can influence change
by telling our stories to friends and colleagues at work. It will help
to engage our thoughts, feelings, share our values and stimulate
innovation (Denning, 2000).
Nurses do tell stories with families and friends but doesn’t always
thinks is a positive thing to do that will improve the care of service
user in a positive way.
Where the storyteller reflects and makes the story authentic to
the audience and feel what the storyteller feels, there must be a
connection with the audience.
The story must be true to the audient and help influence change
to their practice.
The Health and Health (2008) principles of storytelling makes the
ideas real;
 Simplicity; story to be simple and truth.
 Unexpectedness; attract attention and interesting
 Concreteness; what happen help connect the listeners

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 Credibility; make the story credible for audients and reflects on
it.
 Emotions; let the audient feel something about your story
which can influence change to practice.
Example:
How medications errors and missed orders causes the death of a
child has help doctors and nurses to change their clinical practice
and attitudes and improve on service users safety throughout the
country.
A nurse reported that he serve jail sentence because of fatal
medication error create awareness of the National Quality Forum
which consequently influencing change of practice by raising
consciousness of healthcare professionals on patients safety
requirements (Quaid, Thao, and Denham, 2010).
Nurses have the stories to tell that might greatly influence change
to colleagues, in other to do this, the nurse need mastering the
arts of storytelling, courageous enough to influence change in
practice.

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Tips for peers in preparation for their new role and the

ability to influence change.

ASK: Motivate your team and engage them in influencing change you
need to simply involve the team and ask as every individual have
their preference of change and then modify your approach to engage
every team member.

DEFY THE GOLDEN RULE: Get to know your team as individuals as
you may learn how to communicate with them in order to maintain
their preference.

GIVE CREDIT WHERE CREDIT IS DUE: It is vital to value individual
contribution within the team and simply appreciating it by saying
thank you.

SETTING MILESTONE: Setting monthly goals in celebrating success
can keep your team motivated and inspire the team to influence
change.

EMBRACE CHANGE AND NEW IDEA: Implementing and encouraging
creativity of new ideas from your team is vital.

GIVE A FEED BACK THE GOOD THE BAD AND UGLY: It is important to
give feed back to your team as it may encourage the team in being
productive.

LET IT GO: We know no one can do it all as you need to delegate to
give yourself time, the added responsibility to your team will
motivate your team to take it to next level

HAVE FUN: To keep the positive energy flowing let you team come
with idea of having fun.

(Karsh 2012)

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References

Bayliss-Pratt L (2016) ‘Embracing change for nurses’. Nuffield Trust .Available
at: https://www.nuffieldtrust.org.uk/news-item/embracing-change-for-nurses
[Accessed 15th June 2017].

Bowers, B., (2011). Managing change by empowering staff. Nursing Times.
107:32/33.

Denning, S (2000). The Springboard: How Storytelling ignites action in
knowledge-era organisations. Woburn, MA: Butterworth-Heinermann.

Francis, R., (2013) Report of the Mid Staffordshire NHS Foundation Trust Public
Enquiry. London: HMSO.

Health, C., & Health, D. (2008). Made to stick: Why some ideas survive and
others die. New York, NY: Random House.

Hewitt-Taylor, J. (2013) Planning successful change incorporating processes
and people. Nursing Standard. Vol 27, No 38: 35-40.

Iwasiw, C.L. ; Goldenberg, D.; Andrusyszyn, M.A ( 2009)Curriculum
Development in Nursing Education(2nd ed.), Jones & Bartlett, Sudbury.

Karsh, B. (2012) Motivate, Engage and Involve your Team, Training,
Minneapolis, 49,1 .

Keating S.B. (Ed.) (2011) Curriculum Development and Evaluation in Nursing
(2nd ed.), Springer, New York.

Layton, H., (2015) How district nurses can influence organisational
effectiveness in the community. Primary Health Care. 25:10

Lewin, K. (1951). Available at http://www.nursing-theory.org/theories-and-
models/Lewin-Change-Theory.php[ [Accessed on 16th June 2017]

Mitchell, G. (2013) Selecting the best theory to implement planned change in
Nursing management (Harrow, London, England: 1994) 20(1): pp 32-7.

NHS England, (2016). Leading Change Adding Value: A framework for nursing,
midwifery and staff care.  Available at: https://www.england.nhs.uk/wp-
content/uploads/2016/05/nursing-framework.pdf

NICE (2007) How to change practice. Available at:
https://www.nice.org.uk/media/default/about/what-we-do/into-

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practice/support-for-service-improvement-and-audit/how-to-change-practice-
barriers-to-change.pdf .[Accessed 19th June 2017].
NMC (2015) The Code. Available at: www.nmc-uk.org/code.[Accessed 19th June
2017].
Nursing and Midwifery Council (2008) The Code. Standards for conduct,
Nursing and Midwifery Council, (2015) The Code. Available at:
https://www.nmc.org.uk/standards/code/read-the-code-online/
performance and ethics for nurses and midwives. London: NMC.
Rycroft-Malone, J., (2004). The PARIHS Framework—A Framework for Guiding
the Implementation of Evidence‐based Practice. Journal of nursing care quality,
19(4), pp.297-304.
Quaid, D., Thao, J., Denham, C.R (2010). Story Power: The Secret weapon.
Journal of Patient Safety, 6(1), 5-14.
University Hospitals Bristol, (2009) How to: Implement Change Successfully:
Available at: http://www.uhbristol.nhs.uk/files/nhs-
ubht/8%20How%20to%20implement%20change%20v3.pdf

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